200.The answer is d.(American Heart Association Guidelines, 2005. Tinti-
nalli, p 62.)Asystoleis absent heart rhythm or more colloquially, “flat line.”
A common cause of asystole is a disconnected lead or malfunctioning equip-
ment, so the AHA recommends confirmation of asystole by switching to
another leadon the cardiac monitor.Confirmation can also be achieved
with a 12-lead ECG if the equipment is readily available.
Defibrillation(a)is never recommended for asystole. Transcutaneous
pacing(e)failed to show benefit in several randomized controlled trials
and is no longer recommended in the 2005 AHA guidelines for asystole.
The appropriate treatment for asystole includes good CPR, coupled with
epinephrine (b) every 3 to 5 minutes and atropine (c) every 3 to 5 minutes.
A search and treatment of possible underlying etiologies is recommended.
201.The answer is d. (Tintinalli, pp 247-250.) This patient is in
anaphylactic shockfrom a food allergy while dining. Anaphylaxis is a severe
systemic hypersensitivity reactionleading to shock from hypotension and
respiratory compromise. The diagnosis is made clinically. This patient’s reac-
tion began classically with urticarial symptoms of pruritus and flushing. She
then progressed to shock with hypotension and respiratory edema. She
should be treated immediately with oxygen, intramuscular or IV epineph-
rine, corticosteroids, diphenhydramine, and IV fluids. Supplies should also
be ready for intubation and surgical cricothyrotomy.
Hypovolemic shock (a)occurs when there is inadequate volume in the
circulatory system, resulting in poor oxygen delivery to the tissues. Neuro-
genic shock (b)occurs after an acute spinal cord injury, which disrupts sym-
pathetic innervation resulting in hypotension and bradycardia. Cardiogenic
shock(c)is caused by decreased cardiac output producing inadequate tis-
sue perfusion. Septic shock (e)is a clinical syndrome of hypoperfusion,
hypotension, or multiorgan dysfunction caused by infection.
202.The answer is b.(Roberts and Hedges, pp 78-80.)The most serious
complication of ET intubation is unrecognized esophageal intubation with
resultant hypoxic brain injury. Esophageal placement is not always obvi-
ous. The best assurance that the tube is placed into the trachea is to see it
pass through the vocal cords.
(a)The chest radiograph can be misleading and is essentially only use-
ful to identify endobronchial intubation (ie, right main stem bronchus
intubation).(c)Although the chest wall should expand with positive pres-
sure and relax with expiration, this may not occur in patients with small
Shock and Resuscitation Answers 227